Toxicology Critical Care

Use of recreational drugs and subsequent addiction, intentional and accidental drug overdose, exposure to toxic chemicals, such as pesticides and insecticides, and snakebites, especially by venomous snakes, require prompt medical intervention to prevent morbidity and mortality. The team at the toxicology critical care unit manages these patients through early assessment, stabilization, laboratory evaluation, decontamination, antidote administration, enhanced elimination of toxins, and disposition.

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Diseases and conditions

  • Pesticide and Insecticide Poisonings: Insecticide and pesticide poisonings may occur when they are swallowed or absorbed through the skin. The most common symptoms include nausea, headache, increased secretions (saliva, sweating, and tears), and dizziness.
  • Drug Overdose: Drug overdose may occur when the drugs are swallowed, injected, or applied in quantities much higher than recommended. It may be either intentional or accidental.
  • Recreational Agent Overdose: Recreational agents are the chemicals ingested, inhaled, or injected for enjoyment rather than treatment. Some recreational drugs are amphetamine, amyl nitrates, cannabis, cocaine, heroin, ketamine, and MDMA. Taking excessive quantities of these drugs results in their overdose.
  • Snake and Insect Bites: Patients with snake bites have swelling and pain around the bite. However, if the snake is poisonous, symptoms also include headache, fever, numbness, and convulsions. People may also experience an allergic reaction to insect bites.

Procedures and treatment

  • Supportive care: Supportive care is essential to the poisoned patients to maintain the functioning of vital organs until these functions are permanently restored by specific treatment. The supportive therapy includes initial resuscitation, airway management, and circulatory monitoring.
  • Antidote Administration: Antidotes are medications that counter the toxic effects of poison. These agents either modify the toxin kinetics or interfere with their effect at the receptor sites.
  • Toxin-Effect Targeted Therapy: Antidotes work through several mechanisms, and specific toxins are targeted with specific therapies based on the mechanism of action. The mechanisms include binding to the toxin (activated charcoal), enhancement of enzyme function (oximes administered for organophosphorus poisoning), competitive inhibition of enzymes (ethanol administered for methanol poisoning), and competitive receptor blockade (flumazenil and naloxone).
  • Extracorporeal Filtration Therapies: These therapies remove toxins from the blood and play a major role in managing overdose and poisoning. The therapies used are hemodialysis, high-molecular-mass cutoff, continuous renal replacement therapy, hemoperfusion, and plasma exchange.